鞘内注射小剂量吗啡联合硬膜外自控镇痛的临床研究

Clinical study of intrathecal less dose morphine combined patient controlled epidural analgesia

目的评价小剂量吗啡(Mor)鞘内注射超前镇痛联合术后病人硬膜外自控镇痛(PCEA)的镇痛效果。方法选择下肢骨科手术病人60例,随机分成MP组(n=30例)和P组(n=30例)。两组病人均行L2、3或L3、4腰硬联合穿刺术。MP组通过Whitacre腰穿针鞘内注射Mor0.5mg+左布比卡因(S-Bup)10mg;P组仅注入S-Bup10mg。两组均于硬膜外腔头向置管4cm,术后30min行PCEA,均使用相同的镇痛药液(0.225%S-Bup100ml,内含芬太尼0.2mg、氟哌利多3mg),负荷量5ml,持续背景输注量2ml,单次PCA量1ml,锁定时间15min。结果镇痛满意率(VAS≤3)MP组96.67%>P组80%(P<0.05),PCEA药量使用时间MP组(46.0±1.5)h>P组(39.0±1.6)h(P<0.05)。结论小剂量M0r鞘内注射超前镇痛联合术后PCEA镇痛效果满意,副作用少,是较好的联合镇痛方法。

Objective To evaluate the effect of intrathecal less dose morphine（Mor） for preemptive analgesia combined patient controlled epidural analgesia（PCEA）. Methods Sixty patients undergong orthopaedic opration in lower limb were randomly assigned group MP（n=30） and group P（n=30）. The pancture of combining spinalepidural anesthesia was performed at L2.3 or L3.4 In group MP, 0.5mg Mor＋10mgS-bupivacain（S-Bup） were injected through Whitaere （26G）;In group P,only 10mg S-Bup was injected.In the two group epidural catheter was placed at L2.3 or L3.4, PCEA was performed at postoperation 30 min .The PCEA solution was 0.225% S-Bup 100ml （contained 0.2mg fentanyl＋3mg dropefidol）. PCEA included loading dose 5ml,background infusion 2ml/h, PCA bolus lml demand, lockout interval 15min. Results Postoperative analgesia in group MP was satisfactory at 96.67%（〉80% in group P, P 〈 0.05）. Analgesia time of PCEA was（46±1.5）h[〉（39±1.6）h in group P, P 〈 0.05]. Conclusions The intrathecal less dose Mot for preemptive analgesia combined PCEA produces satisfactory postoperative analgesia and less complications, and is a better combining analgesia method.